Cunningham J D, Silver L, Rudikoff D
Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
Mt Sinai J Med. 2001 Sep-Oct;68(4-5):253-61.
Necrotizing fasciitis is an uncommon infectious entity that poses difficult diagnostic and therapeutic management decisions.
This paper addresses the presentation, evaluation and management of the patient with a necrotizing soft tissue infection.
A 54-year-old man presented to his physician with pain and swelling of the left anterior chest wall following a presumed insect bite several days prior. He was treated with oral antibiotics but returned to the office three days later with increased swelling, pain, and erythema in the axilla. Necrotizing fasciitis was diagnosed. He was hospitalized and taken to the operating room for debridement of the chest wall. Extensive necrosis of the skin, subcutaneous tissue and muscle was encountered. Muscle debridement extended from the pectoralis major and both obliques anteriorly to the latissimus dorsi and para-spinalis muscles posteriorly. Multiple operative debridements were performed over several days. The patient developed septic shock requiring blood pressure support, and multiple organ system failure requiring hemodialysis, prolonged ventilatory support and eventual tracheostomy. Split-thickness skin grafts were placed during the third operative debridement and concluded on the 15th day of hospitalization. The patient eventually recovered and on the 53rd hospital day was transferred to the rehabilitation service, where he spent the next four weeks recovering movement in the left arm.
Necrotizing fasciitis is an infectious entity that requires rapid diagnosis, surgical debridement, and tissue coverage if the patient is to survive.
坏死性筋膜炎是一种罕见的感染性疾病，诊断和治疗管理决策都很困难。
本文探讨坏死性软组织感染患者的临床表现、评估和管理。
一名54岁男性，数天前被昆虫叮咬后，左侧前胸壁出现疼痛和肿胀，前往看医生。他接受了口服抗生素治疗，但三天后回到诊所，腋窝处肿胀、疼痛和红斑加重。诊断为坏死性筋膜炎。他住院并被送往手术室进行胸壁清创术。发现皮肤、皮下组织和肌肉广泛坏死。肌肉清创范围从前胸大肌和双侧斜肌延伸至后背阔肌和椎旁肌。在数天内进行了多次手术清创。患者出现感染性休克，需要血压支持，还出现多器官系统衰竭，需要血液透析、长时间通气支持并最终进行气管切开术。在第三次手术清创时进行了分层皮片移植，并在住院第15天完成。患者最终康复，在住院第53天转至康复科，在那里他花了接下来的四周时间恢复左臂活动。
坏死性筋膜炎是一种感染性疾病，如果患者要存活，需要快速诊断、手术清创和组织覆盖。
